When Wendy Foster's doctors first prescribed medication for her neuromuscular disorder, which was slowly weakening her muscles, her insurance company refused to pay for it.
Instead, the company wanted her to try what would eventually add up to a dozen other medications first.
“Oftentimes that would be a narcotics, which tend to depress your lung function, so it would be very difficult for me to do certain things because I couldn't get adequate breath,” Foster said.
It’s a policy known as step therapy, or fail-first. Health insurance companies force chronic pain patients to go through the process of elimination, and prove certain classes of drugs don’t work for them before the insurers will cover what’s prescribed by a doctor. The reason, in part, is because chronic pain is often so difficult to diagnose and most treatments are prescribed based on symptoms.
State lawmakers have proposed a bill, which has moved through committee, that would ban the practice.
"We view well-founded techniques like step therapy, which start with the least cost solution, as essential to accomplishing one of the key objectives of health care reform, ensuring the best and most effective care, while bringing health care costs under control," said a spokesperson with the the Connecticut Association of Health plans.
But Foster thinks fail-first policies actually cost more in the long run for everyone. Today, she has problems standing up and is on disability. She relies on her service dog, Alli, for balance.
“I think I would ask them what kind of value they put on my life that they felt they could put such a dent in what I was able to do,” Foster said.
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